1. Care of the Elderly and Cultural Competence

2. Care of the Elderly and Cultural Competence
Jan is a 75 year old female. She was admitted to the hospital today for management of a subdural hematoma after falling yesterday at home. She has a history of early onset dementia.
Jan’s eldest daughter is her primary caregiver.
Jan has lived with her daughter since her husband passed away four years ago.
Jan’s daughter works from home and has three children under the age of 8.
Jan has one other son and daughter that each live out of state.
You read in Jan’s medical record that she stated she “just fell.” She didn’t know why.
Care of the Elderly and Cultural Competence

3. Care of the Elderly and Cultural Competence
You complete your assessment.
You notice several bruises on Jan’s back that seem to be in various stages of healing.
You ask Jan how she fell. Her daughter answers and says her mother tripped over a rug.
Jan turns away and won’t answer the other questions you ask her.
Jan’s daughter won’t leave her side.
During your assessment you note the following:
Jan is resting in bed
Mild tenting and dry mucous membranes.
BP: 102/60
HR: 90
Poor personal hygiene.
Jan is supposed to have dentures but her daughter said she does not have them.
Care of the Elderly and Cultural Competence

4. Care of the Elderly and Cultural Competence
What do you suspect?
Care of the Elderly and Cultural Competence

5. Care of the Elderly and Cultural Competence
What do you suspect?
Jan is showing signs of dehydration
She also show signs of mistreatment.
Care of the Elderly and Cultural Competence

6. Care of the Elderly and Cultural Competence
What type of elder mistreatment do you suspect?
Care of the Elderly and Cultural Competence

7. Care of the Elderly and Cultural Competence
What type of elder mistreatment do you suspect?
Physical Abuse
Neglect
Psychologic Abuse
Care of the Elderly and Cultural Competence

8. Care of the Elderly and Cultural Competence
What are the manifestations of each?
Physical Abuse
Neglect
Psychologic Abuse
Care of the Elderly and Cultural Competence

9. Care of the Elderly and Cultural Competence
What are the manifestations of each?
Physical Abuse
Bruises, bilateral injuries, repeated injuries in various stages of healing over sedation, utilization of several emergency departments.
Neglect
Untreated or infected pressure ulcers on sacral area, heels; loss of body weight; laboratory values showing dehydration or malnutrition (↓ serum protein)
Psychologic Abuse
Depression, withdrawn behavior; agitation; ambivalent attitude toward caregiver/family member.
Care of the Elderly and Cultural Competence

10. Care of the Elderly and Cultural Competence
What are your next steps?
Care of the Elderly and Cultural Competence

11. Care of the Elderly and Cultural Competence
Follow your hospital’s policy. This usually includes:
Notifying the physician.
Contact Adult Protective Services
Long-Term Care Ombudsman (for patients in long term care facilities)
Law Enforcement (esp. if the state does not have Adult Protective Services)
Contact social worker for assistance.
Care of the Elderly and Cultural Competence

12. Care of the Elderly and Cultural Competence
What factors could be contributing to the mistreatment?
Care of the Elderly and Cultural Competence

13. Care of the Elderly and Cultural Competence
What factors could be contributing to the mistreatment?
Decreased social support.
Jan’s daughter has assumed primary care for her with no other support noted. Jan’s daughter also has three young children.
Care of the Elderly and Cultural Competence

14. Care of the Elderly and Cultural Competence
What factors could be contributing to the mistreatment?
Abuse must always be reported.
It is also important to recognize Jan’s daughter lacks support. Jan and her daughter may benefit from education, the identification of additional resources or support groups.
Resources:
Care of the Elderly and Cultural Competence

15. Care of the Elderly and Cultural Competence
THE END
Care of the Elderly and Cultural Competence